title: Whole-exome sequencing supports genetic heterogeneity in childhood apraxia of speech.
abstract: BACKGROUND
  Childhood apraxia of speech (CAS) is a rare, severe, persistent pediatric motor speech disorder with associated deficits in sensorimotor, cognitive, language, learning and affective processes. Among other neurogenetic origins, CAS is the disorder segregating with a mutation in FOXP2 in a widely studied, multigenerational London family. We report the first whole-exome sequencing (WES) findings from a cohort of 10 unrelated participants, ages 3 to 19 years, with well-characterized CAS.
  
  
  METHODS
  As part of a larger study of children and youth with motor speech sound disorders, 32 participants were classified as positive for CAS on the basis of a behavioral classification marker using auditory-perceptual and acoustic methods that quantify the competence, precision and stability of a speaker's speech, prosody and voice. WES of 10 randomly selected participants was completed using the Illumina Genome Analyzer IIx Sequencing System. Image analysis, base calling, demultiplexing, read mapping, and variant calling were performed using Illumina software. Software developed in-house was used for variant annotation, prioritization and interpretation to identify those variants likely to be deleterious to neurodevelopmental substrates of speech-language development.
  
  
  RESULTS
  Among potentially deleterious variants, clinically reportable findings of interest occurred on a total of five chromosomes (Chr3, Chr6, Chr7, Chr9 and Chr17), which included six genes either strongly associated with CAS (FOXP1 and CNTNAP2) or associated with disorders with phenotypes overlapping CAS (ATP13A4, CNTNAP1, KIAA0319 and SETX). A total of 8 (80%) of the 10 participants had clinically reportable variants in one or two of the six genes, with variants in ATP13A4, KIAA0319 and CNTNAP2 being the most prevalent.
  
  
  CONCLUSIONS
  Similar to the results reported in emerging WES studies of other complex neurodevelopmental disorders, our findings from this first WES study of CAS are interpreted as support for heterogeneous genetic origins of this pediatric motor speech disorder with multiple genes, pathways and complex interactions. We also submit that our findings illustrate the potential use of WES for both gene identification and case-by-case clinical diagnostics in pediatric motor speech disorders.
authors.affiliation: Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI, 53705, USA. shriberg@waisman.wisc.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Worthey
authors.forename: Gordana
authors.initials: G
authors.lastname: Raca
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Laffin
authors.forename: Brandon M
authors.initials: BM
authors.lastname: Wilk
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Harris
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Jakielski
authors.forename: David P
authors.initials: DP
authors.lastname: Dimmock
authors.forename: Edythe A
authors.initials: EA
authors.lastname: Strand
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Shriberg